Lee Poh Wah, the CEO of Lien Foundation, recently made the news with his anti-establishment views that Singapore’s nursing homes were inadequate.
Lee claimed that:
(a) money and sustainability is not an issue;
(b) nursing homes here are “soulless” and regimented and patients are suffering in long wards;
(c) there is a market failure as other countries such as Japan can provide much better care for not much more, partly because long term care insurance in Japan led to higher private NH participation with more innovative products;
(d) MOH is obsessed with capacity and not pausing to think; and
(e) we can achieve a lower manpower by asking elderly to do things themselves.
Allow me to challenge some of his claims before sharing my own thoughts on this subject.
Sustainability is a key issue not just important for Singapore but for many countries around the world. Many countries, including japan, are struggling with sustainability and the burden of care. This is especially important in a maturing economy and diminishing ratio of working population vs senior population.
Unfair to say that nursing homes here are soulless and cold. Many nursing homes invest in good psycho social activities and many homes have regular programming and volunteer visitation.
Quantity of care is also important, because there will be a higher number of seniors needing care, not just now, not just 2020, but also beyond that. Even in Japan, there is a long queue for nursing home beds, and they are also grappling with care worker shortage etc. Therefore we are fortunate the government takes a long term view and is responsible and does not just blindly copy others. Instead of being self-righteous, we should respect that different people have different needs, and affordability and access to care are important for Singaporeans.
For seniors who are well, why are we not encouraging them to stay at home with home care but want their children to send them to single rooms in nursing homes?
Having said that, here are some points which Lee either failed to acknowledge or did not want to.
“If we are not meeting the needs of the elderly and their families, it is pointless to talk about sustainability.”
There are low income Singaporeans who need affordable care
We are in a slowdown now and people are out of jobs
How can sustainability be “pointless” when it will be taxpayers paying for it and we will have fewer younger population earning to pay for the care of a larger group of seniors?
“I have visited many nursing homes in Singapore and overseas – places like Japan, Australia, Finland. I can’t help but feel we are stuck in a time warp 20 years ago where the rest of the world has moved on. When I see some of these nursing homes here and what are the prices they are charging, I ask myself how come we are not getting value for money in Singapore?
A typical nursing home costs about S$2,300 or S$2,800 and you’re staying inside an 8-bedder dorm. And you look at the quality of the programmes, the food, the lifestyle and what you can get in Japan for almost the same or slightly more. It worries me.”
Not many of us have time and money to visit countries like him
Single bedded rooms in Japan costs $5000 to $10,000.
Private nursing home in Singapore costs $7500.
“Too many of our Singapore nursing homes are cold factories housing warm bodies.”
Unfair. Many of the VWO operated homes have many programmes for the elderly like art and music therapy. They also bring these elderly for outings.
“In Japan, they stopped building 6-bedder wards 40 years ago. In fact, single rooms have been a norm for almost a decade. You can see that also in terms of their policies, their programmes, and their professional practice, they are way ahead of us.”
“In Japan, the dynamic is such that the majority of the nursing homes are operated by the private sector and of course there is a small section that are Voluntary Welfare Organisation-driven. The transformation just happened in the year 2000. I think it is partly because of the introduction of the long-term care insurance. Because of that, many in the private sector came in to offer innovative services.”
Japan’s long term care costs have ballooned over the past decade. Many people in Japan are talking about the problem of exploding costs by 2025.
“When it comes to manpower, if there are toilets within their own rooms, they will be able to clean themselves. Things like that will reduce your need for manpower. It’s a simple premise. The best way to save on manpower and to enhance productivity is to encourage the elderly to do things themselves. By doing things by themselves, they have a sense of autonomy and there’s a sense of achievement.”
Why do these seniors need to be in nursing homes in the first place?
In Singapore, many of them own HDB flats – why don’t we support them with home and day care then?
For those bedridden or bed bound, what Lee Poh Wah suggested is not practical and cannot happen. Is it safe to leave these patients in a room by themselves?
“the fixation with meeting KPIs to build 5,000 additional nursing home beds by 2020.”
We will need more nursing home beds as our population grows even older in future
Over half a million seniors in Japan waiting for nursing home beds.
“So I think it goes back to the point that the real enemy, the real disease is apathy, complacency and mediocrity and we each have to do our part to address this.”
Sounds self-righteous, Mr know-it-all?
And in case you are wondering, I did not make this all up. The following are my references from credible sources.
Friends of #onwardsingapore
Bloomberg article (Feb 2015) highlights that 520,000 Japanese seniors on wait list for nursing home placement nationwide.
Professor Kato Hisakazu of Meiji University argues that there are sustainability concerns both with overall government finances and also financial condition of long term care insurance. He highlights that expansion of long term care market directly impacts long term care insurance premium and increase in cost in long term care increases both premium and public fiscal burden. He argues for “suppressing demand” including better targeting care benefits, organising care into regional systems and collective housing for seniors etc.
Paper in 2011 that shows how that institutionalized care was a key driver of long term care expenditure. http://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-11-103
Paper showing how long term care costs have doubled from 4 trillion yen in FY2000 to 8.4trillion yen in FY 11 after the introduction of the long term care insurance programmes. The National Council on Social Security (2006) estimates that LTCI costs will continue to explode in the future, increasing from 19 to 24 trillion yen by FY 2025 or (from 3.2% to 4.1% of GDP)